SONOWORLD : Complete left internal carotid artery occlusion

Username

Password

175,565 Registered Members as of 08/20/2019.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Vascular » Cerebrovascular

Complete left internal carotid artery occlusion

« Back to Listing

Author(s) :

S. Manohar, MD, DMRD

Presentation This is a patient who gave a prior clinical history of left carotid endarterectomy. His current complaints involve loss of vision in the left eye.

Caption: Spectral waveform analysis of left ICA origin

Description: No flow is recorded in the left internal carotid artery.

Caption: Spectral waveforms of left CCA and vertebral artery

Description: The left CCA demonstrates an externalized waveform. The vertebral artery waveform is normal.

Caption: Color Doppler image at left carotid bifurcation

Description: An echogenic thrombus is seen occluding the left internal carotid artery. The left common carotid artery appears normal.

Caption: Spectral waveforms of right ECA and vertebral artery

Description: The right external carotid artery and the vertebral artery reveal normal arterial waveforms. [Contrast it with the waveform seen in image 2]

Caption: Spectral waveforms of right common and ICA

Description: Normal arterial waveforms are noted in the right common and internal carotid artery.

Caption: Spectral waveforms of the left MCA and ACA

Description: Both these arteries show flow towards the transducer. This indicates normal flow in the MCA, but indicates reversal of flow in the ACA as the normal ACA flow is away from the probe.

Caption: Spectral waveforms of left MCA and ACA

Description: The left anterior cerebral artery shows reversed flow.

Caption: Waveforms of both ACA from left temporal window

Description: There is increased flow in the right anterior cerebral artery towards the transducer and flow reversal in the left anterior cerebral artery.

Caption: Spectral waveforms of both the MCAs

Description: This is the right and left middle cerebral arteries sampled from the left temporal window. Both show flow in the opposite direction which is normal.

Differential Diagnosis Complete left internal carotid artery occlusion

Final Diagnosis Complete left ICA occlusion with changes in the ipsilateral anterior circulation as described.

Discussion The transcranial Doppler findings in cases of ICA occlusion can help to identify concurrent intracranial occlusions or compensatory changes that occur in the anterior circulation. The spectrum of findings include
- reversed flow in the ipsilateral ACA,
- reduced flow velocity in the ipsilateral MCA and
- elevated flow velocity in the contralateral ACA [all these findings are noted here].

A few other findings that have been noted in literature include reversed flow in ipsilateral ophthalmic artery and concurrent absent flow in the arteries of the anterior circulation.

Case References 1. Demchuk A., Christou I., Wein T., Felberg R., et al. Specific Transcranial Doppler Flow Findings Related to the Presence and Site of Arterial Occlusion. Stroke. 2000; 31:140.

Other contents by this AuthorOther Cases in This Category

Vascular >> Cerebrovascular

Superficial temporal artery pseudoaneurysm
A young man with previous history of motor vehicle accident one month prior with injury to the forehead now presents with a pulsatile swelling above his right eyebrow.

Bilateral fibromuscular dysplasia of the carotid artery
A 57 year old woman presented with chronic headaches. When all investigations done on her returned normal, bilateral carotid Doppler study was performed.

Carotid body tumor
A 17 year old girl presents with a non-pulsatile neck mass of a hard consistency. An ultrasound of the neck was performed.

Carotid-cavernous fistula and carotid artery aneurysm
A 60 year old woman presented for sudden visual loss in the right eye, exophthalmos, chemosis and proptosis. Functional ophthalmologic examination revealed immobility of the right eye, weak ...

Right carotid artery occlusion with reversal of flow in the right ECA and plaque in the left CCA
This is a duplex Doppler study in a patient with left carotid bruit. The patient has hypertension, elevated cholesterol, diabetes and history of radiation 8 years ago for laryngeal carcinoma. In ...

Acute right internal jugular vein thrombosis
This is a neck ultrasound performed in a 71-year-old man with a history of syncope, subdural hematoma and septicemia. Patient had a right IJV catheter.

Left dural arterio-venous malformation
This is the scan of the neck in a 65-year-old woman with complaints of audible bruits in the left ear and papilledema. She has a past history of left Sylvian fissure meningioma.